Question:
Aetna
Does anyone know how often and how quickly Aetna PPO approves for RNY? I have a BMI of almost 60 and only 1 co-morbidity (sleep apnea) which was discovered from the insurance required sleep study. — a_voluptuous_one (posted on September 9, 2008)
September 9, 2008
Hi - I have aenta PPO and had to get their approval 3 years ago. they had
a requirement of 3month program with doctor if i didn't have 6 months
documented history of weight loss with a doctor. since i dind't have the 6
months i did the 3 months with my doctor. plus i had several comorbidities
(diabetes, high bp, high lipids). the biggest thing with aetna is making
sure that you have all that they require before you submit. my doctor
accidentaly submitted early without all the documenttation and i was
denied. he then had to write an appeal. once the appeal was written I had
approval within 2 weeks. they were pretty quick -but I also made sure I
met all their qualifications. good luck with this journey. i did it 3
years ago and don't regret it. i had a BMI around 45+. weighed over
320lbs. lost 140lbs. now have gained 10-20lbs due to eatting and working
out but still love the results. its not a cure - but a tool to use. its a
wild journey you will go through - the changes in your body and changes in
your relationships. my relationship with my husband changed - for the
good... good luck!!
— akirsch
September 9, 2008
much depends on your plan i have it and was approved in less then 4 weeks
but i know persons that it took longer then. hope this helps-jeff
— jeffinMI
September 9, 2008
you need to find the right person at Aetna and ask them these quesitons.
That way you know for sure what you have to do and how long it will likely
change. If someone tells you somthing on this board it doesn't mean that
the same thing will happen with you. You need to get the info direct so
you don't waste a lot of time.
good luck.
— cjjordan
September 9, 2008
I assumed they were taking forever, but it was my doctor's office holidng
up the decision. They said they had submitted, when they hadden't. As
soon as I found out they actually submitted the paperwork to Aetna, I
followed up the next day and received approval the following day.
— [Deactivated Member]
September 9, 2008
Thank you all for your help.
— a_voluptuous_one
September 10, 2008
I have Aetna PPO but it depends on your plan. I had to do a 3 month
program of Doc and Nut visits and have a 5 year history of weight issues
and co morbidities. Once I did all that they submitted my paperwork and
had an approval in 24 hours. Because I did their program they couldn't
deny me. My GF has Aetna but her plan doesn't cover RNY but will do
lapband. So call your provider. Good Luck.
— Belanna
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